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The aim of the work was to evaluate the clinical and pathogenetic links of osteoarthritis (OA) with the qualitative composition of the drinking water in zones of patients’ residence. Material and Methods. The observation included 133 patients with primary OA aged 58.90 ± 0.83 years. In 33 urban and rural regions we have assessed levels of hardness and salinity of drinking water, concentration of chlorides, sulfates in it, phosphates and nitrates, content of toxic trace elements (Ba, Li, Ni, Pb). Results. Poor quality of drinking water in the regions where people live lead to the development of OA at a younger age, which subsequently determines the cumulative severity of articular syndrome, the nature of bone-destructive changes in the joints (osteoporosis, bone erosion, cartilage flaps), the formation of symptomatic reactive synovitis (chloride and nitrates concentration), the rate of disease progression, the emergence of intraarticular calcification deposits, osteophytosis and epiphyseal osteoporosis (degree of water salinity and hardness). The severity of OA and the rate of progression of bone-destructive changes in the joints depend on the level of trace elements, which determine the prevalence of joint syndrome, the development of Heberden’s and Bouchard’s nodes, spondylopathy, degree of reactive synovitis, osteoporosis, subchondral sclerosis, ligamentosis, intraarticular cartilage flaps and Hoffa’s bodies, and high content of Pb is a risk factor for unfavorable course of the disease. Conclusions. There were identified certain clinical and pathogenetic correlation of OA and the qualitative composition of drinking water in the regions where people live., Целью работы стала оценка клинико-патогенетических связей остеоартроза (ОА) с качественным составом питьевой воды в зонах проживания больных. Материал и методы. Под наблюдением находились 133 больных первичным ОA в возрасте 58,90 ± 0,83 года. Оценивали в 33 городских и сельских регионах уровни жесткости и минерализации питьевой воды, концентрации в ней хлоридов, сульфатов, фосфатов и нитратов, содержание токсичных микроэлементов (Ba, Li, Ni, Pb). Результаты. Низкое качество питьевой воды в регионах проживания людей способствует развитию ОА в более молодом возрасте, что в последующем определяет интегральную тяжесть артикулярного синдрома, характер костно-деструктивных изменений в суставах (развитие остеопороза, остеоузур, хондромных тел), формирование манифестного реактивного синовита (концентрации хлоридов и нитратов), темпы прогрессирования заболевания, появление внутрисуставных отложений кальцинатов, остеофитоза и эпифизарного остеопороза (степень минерализации и жесткости воды). Тяжесть ОА и темпы прогрессирования костно-деструктивных изменений со стороны суставов зависят от уровня микроэлементов, которые определяют распространенность суставного синдрома, развитие узелков Гебердена и/или Бушара, спондилопатии, степень реактивного синовита, остеопороза, субхондрального склероза, лигаментоза, интраартикулярных хондромных тел и тел Гоффа, а высокое содержание Pb является фактором риска неблагоприятного течения заболевания. Выводы: выявлены определенные клинико-патогенетические связи ОА с качественным составом питьевой воды в регионах проживания больных., Метою роботи стала оцінка клініко-патогенетичних зв’язків остеоартрозу (ОА) з якісним складом питної води в зонах проживання хворих. Матеріал і методи. Під спостереженням перебували 133 хворі на первинний ОA віком 58,90 ± 0,83 року. Оцінювали в 33 міських і сільських регіонах рівні жорсткості й мінералізації питної води, концентрації в ній хлоридів, сульфатів, фосфатів і нітратів, вміст токсичних мікроелементів (Ba, Li, Ni, Pb). Результати. Низька якість питної води в регіонах проживання людей сприяє розвитку ОА в молодшому віці, що в подальшому визначає інтегральну тяжкість артикулярного синдрому, характер кістково-деструктивних змін у суглобах (розвиток остеопорозу, остеоузур, хондромних тіл), формування маніфестного реактивного синовіту (концентрації хлоридів і нітратів), темпи прогресування захворювання, появу внутрішньосуглобових відкладень кальцинатів, остеофітозу й епіфізарного остеопорозу (ступінь мінералізації та жорсткості води). Тяжкість ОА і темпи прогресування кістково-деструктивних змін з боку суглобів залежать від рівня мікроелементів, які визначають поширеність суглобового синдрому, розвиток вузликів Гебердена та/або Бушара, спондилопатії, ступінь реактивного синовіту, остеопорозу, субхондрального склерозу, лігаментозу, інтраартикулярних хондромних тіл та тіл Гоффа, а високий вміст Pb є чинником ризику несприятливого перебігу захворювання. Висновки: виявлені певні клініко-патогенетичні зв’язки ОА з якісним складом питної води в регіонах проживання хворих.

Несмотря на современные достижения акушерства и детской хирургии, выживаемость новорожденных при врожденной диафрагмальной грыже не превышает 50 %. В статье описывается клинический случай рождения ребенка с врожденной диафрагмальной грыжей с благоприятным исходом после своевременной хирургической коррекции. При отсутствии в нашем клиническом случае пренатальной (отсутствие диагностики и динамического наблюдения в период гестации – поздняя явка беременной женщины в женскую консультацию), но ранней постнатальной диагностики, стало возможным провести эффективную хирургическую коррекцию данного врожденного порока развития у новорожденного., Despite current advances in obstetrics and pediatric surgery, the survival rate of newborns with congenital diaphragmatic hernia does not exceed 50 %. This article describes a clinical case of a child with congenital diaphragmatic hernia with a favorable outcome after timely surgical correction. In our clinical case, the absence of prenatal diagnostics (lack of diagnosis and dynamic monitoring during gestation – late appearance of the pregnant woman in the antenatal clinic), but early postnatal diagnosis allowed for effective surgical correction of this congenital malformation in the newborn.

ObjectivesThe systemic form of scleroderma (SSc) in children is a very rare disease; therefore, it is recognized relatively late, which increases the risk of complications. The aim of the study was to assess the clinical symptoms of juvenile systemic sclerosis (JSSc) in our cohort patients.Material and methodsA group of (N = 22) scleroderma patients aged between 2 and 16 years were observed. Demographic data and all clinical results obtained during 16 years of observation in the clinic of rheumatic diseases of developmental age were collected and analysed.ResultsIn all observed children the major JSSc criterion was found, i.e. skin thickening proximal to the metacarpal phalangeal and/or metatarsophalangeal joints. Other symptoms are presented as follows: nailfold capillary abnormalities – 100%, Raynaud’s phenomenon – 90.9%, sclerodactyly – 27.3%, digital tip ulcers – 27.3%, dysphagia – 18.2%, gastroesophageal reflux – 27.3% (assessed in only 10 children), arrhythmias – 22.7%, heart failure – 9.1%, new-onset arterial hypertension – 9.1%, pulmonary fibrosis – 72.7%, pulmonary arterial hypertension – 9.1%, neuropathy – 13.6%, carpal tunnel syndrome – 4.5%, tendon friction rubs – 4.5%, arthritis – 22.7%, and myositis – 13.6%. There were no cases of renal crisis. Decreased diffusing capacity of oxygen was confirmed in 12 patients (58.3%). The presence of antinuclear antibodies was noticed in 86.7% of patients, and among SSc selective autoantibodies: anticentromere – 31.8%, anti-topoisomerase I – 18.2%, anti-PM-Scl 100 or 75 – 45.5%, anti-RP11, Th/To, PCNA in total in 27.3% were presented. In 4.5% of cases, apart from the presence of anti-PM-Scl autoantibodies, positive lupus band test, reduced concentration of complement, and antiphospholipid antibodies were also found. In 59% of studied children, the body mass index was below the 25th percentile.ConclusionsThe presented retrospective analysis shows that the occurrence of Raynaud’s phenomenon with changes in nailfold capillaroscopy is the best screening toll for the assessment of risk of JSSc. All patients of developmental age with Raynaud’s phenomenon, especially in the case of the appearance of antinuclear antibodies, should be monitored with capillaroscopy regardless of other laboratory or imaging tests.

Ebola virus disease — natural focal, extremely dangerous infection with severe course characterized by fever, hemorrhagic syndrome and multiple damage to vital organs and body systems. The article describes the epidemiological situation related with the registration of cases, provides the characteristics of the pathogen, mechanisms of development, peculiarities of disease in children. Methods of the treatment and prevention of this disease are described from the modern point of view., В статье освещена эпидемиологическая ситуация, связанная с регистрацией случаев геморрагической лихорадки Эбола, охарактеризованы возбудители, механизмы развития, особенности течения болезни у детей. С современных позиций описаны методы лечения и профилактики заболевания. Геморрагическая лихорадка Эбола — природно-очаговая особо опасная инфекция с тяжелым течением, характеризующаяся лихорадкой, геморрагическим синдромом и полиорганными повреждениями жизненно важных органов и систем организма., У статті висвітлено епідеміологічну ситуацію, пов’язану з реєстрацією випадків геморагічної лихоманки Ебола, охарактеризовано збудник, механізми розвитку, особливості перебігу хвороби в дітей. Із сучасних позицій описано методи лікування й профілактики захворювання. Геморагічна лихоманка Ебола — природно-вогнищева особливо небезпечна інфекція з тяжким перебігом, що характеризується лихоманкою, геморагічним синдромом і поліорганними пошкодженнями життєво важливих органів і систем організму.

Introduction: the SARS-CoV-2 pandemic affected a large part of the population of La Libertad, among them, the population of Florencia de Mora whose hospital played an important role in the care of patients diagnosed with COVID-19. Objective: to determine the epidemiological clinical characteristics of patients diagnosed with SARS-CoV-2 treated at the care center. Methods: Retrospective observational descriptive study, with a population of 2622 patients treated in the COVID-19 triage, taking into account the molecular test and the rapid serology test for the detection of SARS-CoV-2. Results: SARS-CoV-2 was detected in 74.90% (1155) of patients. The months with the highest number of cases were June and July with 29.4% (340) and 37.4% (432), respectively. The predominant age group was 27- 59 years with 77.9% (900) and males with 57.5% (664). Regarding the clinical profile, the most frequent comorbidity was hypertension with 6.9% (80), obesity and overweight with 3.7% (43) and the most frequent symptoms were cough 62.9% (726) and odynophagia 55.7% (643). Conclusions: 75 out of 100 screened patients had SARS-CoV-2, predominantly males, the age group of 27-59 years, hypertension, obesity and overweight as comorbidity, cough and odynophagia as the most frequent symptoms.

Актуальність. Досі ювенільний ревматоїдний артрит залишається тяжким за проявами та наслідками захворюванням, при якому інвалідизація пацієнтів може формуватися з перших років патологічного процесу. Сьогодні науковий і практичний інтерес до цього захворювання значною мірою стосується технологій застосування біологічної терапії. Однак чітке знання особливостей перебігу хвороби, своєчасне призначення адекватної традиційної терапії в значної частини осіб можуть запобігти ранній інвалідизації. Мета дослідження: дати оцінку проявам ювенільного ревматоїдного артриту на різних етапах еволюції захворювання, починаючи з дебюту, й визначити наслідки хвороби при тривалому спостереженні. Матеріали й методи. Проаналізовано еволюцію суглобової форми ювенільного ревматоїдного артриту в 117 хворих віком 2–18 років, які перебували на стаціонарному лікуванні протягом 2012–2015 рр. у клініці ДУ «Інститут охорони здоров’я дітей та підлітків НАМН України». Оцінка проявів захворювання проводилася на кожному році розвитку процесу. Кінцева тривалість захворювання становила 5–10–15 років. Результати. Установлено, що на тлі традиційного лікування відбувається щорічне невпинне прогресування змін у суглобах, що проявляється збільшенням кількості уражених суглобів, розвитком їх функціональної недостатності та рентгенологічних змін, мікроциркуляторними порушеннями. З перших років процесу спостерігається чітке переважання поліартритів (р < 0,01). Отримано дані, що на показники прогресування хвороби, безумовно, впливають пізнє встановлення правильного діагнозу та запізніле призначення базисних засобів (за даними спостереження, тільки 12 % хворих починають їх отримувати на завершення першого року хвороби). Висновки. На позитивні наслідки ювенільного ревматоїдного артриту впливає не тільки своєчасне призначення базисних препаратів, але й тривале (роками) їх використання. Прогресування ювенільного ревматоїдного артриту, що нерідко спостерігається на тлі мінімальної активності, потребує регулярного планового спостереження хворих і ретельного їх обстеження як клінічними, так і апаратними методами., Актуальность. До настоящего времени ювенильный ревматоидный артрит остается тяжелым по проявлениям и исходам заболеванием, при котором инвалидизация пациентов может формироваться уже с первых лет патологического процесса. В настоящее время научный и практический интерес к этому заболеванию в значительной мере касается технологий применения биологической терапии. Однако четкие знания особенностей течения болезни, своевременное назначение адекватной традиционной терапии у значительной части больных могут предотвратить раннюю инвалидизацию. Цель исследования: дать оценку проявлениям ювенильного ревматоидного артрита на различных этапах эволюции заболевания, начиная с дебюта, и определить последствия болезни при длительном наблюдении. Материалы и методы. Проанализирована эволюция суставной формы ювенильного ревматоидного артрита у 117 больных в возрасте 2–18 лет, которые находились на стационарном лечении в течение 2012–2015 гг. в клинике ГУ «Институт охраны здоровья детей и подростков НАМН Украины». Оценка проявлений заболевания проводилась на каждом году развития процесса. Конечная продолжительность болезни составила 5–10–15 лет. Результаты. Установлено, что на фоне традиционного лечения наблюдается ежегодное упорное прогрессирование изменений в суставах, которое проявляется увеличением количества пораженных суставов, развитием их функциональной недостаточности и рентгенологических изменений, микроциркуляторными нарушениями. С первых лет процесса отмечается четкое преобладание полиартритов (р < 0,01). Получены данные, что на показатели прогрессирования болезни, безусловно, оказывают влияние позднее установление правильного диагноза и запоздалое назначение базисных препаратов (по данным наблюдения, лишь 12 % больных начали их получать по завершении первого года болезни). Выводы. На положительные последствия ювенильного ревматоидного артрита влияет не только своевременное назначение базисных препаратов, но и длительное (годами) их использование. Прогрессирование болезни, которое нередко происходит на фоне минимальной активности, требует регулярного планового наблюдения больных и тщательного их обследования как клиническими, так и аппаратными методами., Background. In our time, juvenile rheumatoid arthritis is a disease with difficult symptoms and consequences, in which patients’ disability can be formed in the first years of the pathological process. Scientific and practical interest to this disease in our time basically concerns the use of biological treatment technologies. However, a clear knowledge of disease characteristics, the timely prescription of adequate conventional therapy, can prevent early disability in a significant proportion of people. Research purpose was to evaluate manifestations of juvenile rheumatoid arthritis at different stages of evolution of the disease, since onset, and to determine consequences of the disease during long-term follow-up. Materials and methods. Authors examined the evolution of articular form of juvenile rheumatoid arthritis in 117 patients aged 2 to 18 years, who were hospitalized during the 2012–2015 in the clinic of State Institution «Institute of Children and Adolescents Health Care of the National Academy of Medical Sciences of Ukraine». Assessment of disease manifestations was performed each year of the process development. The final duration of the disease was 5–10–15 years. Results. It was found that on the background of traditional treatment, there is persistent annual progression of changes in the joints, which is manifests in increasing the number of affected joints, lack of its function and radiographic changes, microcirculatory disorders. From the first years of the process, there was observed a clear predominance of polyarthritis (p < 0.01). The data were obtained that disease progression rates were certainly affected by delayed establishing of the correct diagnosis and the administration of basic treatment (according to observation, only 12 % of patients began to receive it at the end of the first year of illness). Conclusions. Positive consequences of juvenile rheumatoid arthritis depend not only on timely prescription of basic drugs, but also on the long-term (years) its use. Preventing the progression of juvenile rheumatoid arthritis, which often takes place against the background of minimal activity, requires regular routine observation of patients and careful examination by both clinical and instrumental methods.

The current SARS-CoV-2 pandemic poses numerous health challenges, including the adequate use and proper interpretation of the different available tests in different clinical settings. As any diagnostic test, those of SARS-CoV-2 have methodological limitations of sensitivity (S) and specificity (E), which eventually determine their positive (PPV) and negative (NPV) predictive value. Furthermore, their diagnostic performance depends on the clinical context in which these tests are used, that is, on the pretest probability. This article: (1) reviews the main methodological aspects that influence the S, E, PPV and NPV of the most common SARS-CoV-2 diagnostic tests; and, (2) discusses its diagnostic interpretation in different clinical settings.La actual pandemia de SARS-CoV-2 plantea numerosos retos sanitarios, entre los que destaca el uso adecuado e interpretación correcta de las pruebas diagnósticas disponibles en diferentes contextos clínicos. Como cualquier prueba diagnóstica, las de SARS-CoV-2 tienen limitaciones metodológicas de sensibilidad (S) y especificidad (E) que determinan su valor predictivo positivo (VPP) y negativo (VPN). Además, su rendimiento diagnóstico depende del contexto clínico en el que se evalúen, es decir de la probabilidad pretest. Este artículo revisa los principales aspectos metodológicos que influyen sobre la S, E, VPP y VPN de las pruebas diagnósticas de SARS-CoV-2 más habituales y discute su interpretación diagnóstica en diferentes escenarios clínicos.

Paroxysmal kinesigenic dyskinesia belongs to the group of primary dyskinesias, which also includes paroxysmal non-kinesigenic dyskinesia and exercise-induced paroxysmal dyskinesia. Due to the rarity of this disease group, as well as to the existence of a wide spectrum of disorders associated with transient movement abnormalities, the diagnosis is often difficult. A thorough analysis of clinical presentation, objective registration of paroxysmal events (video-electroencephalography monitoring) is helpful in the diagnosis. The most common causes of paroxysmal kinesigenic dyskinesia are mutations in the PRRT2 gene, while paroxysmal non-kinesigenic dyskinesia is caused by the MR1 gene mutations.The paper describes a clinical case of a 13 year old patient with acute, movement-associated, shortterm dystonic, choreic and ballistic hyperkinesis attacks. The patient had been treated with the diagnosis of epilepsy, tics, and dystonia for a long time without any effect. During diagnostic workup, a mutation in the PRRT2 gene intron was identified by a new generation sequencing of gene panel. Despite of this mutation has not been previously described, taking into account the type of Informed consent statement hyperkinesis attacks, association of their onset to movements, as well as the data of instrumental assessments, the diagnosis of paroxysmal kinesi-genic dyskinesia was made. Treatment with carbamazepine was successful with complete control over hyperkinesis.The diagnosis of paroxysmal dyskinesias remains based on the analysis of clinical picture and the trigger type. Molecular genetic diagnostics, with consideration of the most frequent causal mutations related to these conditions, can minimize both time and financial costs.

Background. Acne is one of the most common chronic dermatoses, which occurs in almost 8590% of the population. The disease manifests itself as polymorphic eruptions and is characterized by a recurrent and torpid course. Acne treatment is constantly improving, requires an integrated approach and long courses of therapy. Aims. To increase the effectiveness of acne therapy using new opportunities and promising methodological approaches using a combination of the therapeutic effects of platelet-rich plasma (PRP) and topical bacteriophage therapy. Materials and methods. The study included 30 patients with papulopustular acne of mild and moderate severity. Patients with mild acne were treated with PRP procedures as monotherapy. For moderate acne, PRP therapy was combined with regular applications of a staphylococcal bacteriophage (NPO Microgen, Nizhny Novgorod, Russia). The treatment was carried out on an outpatient basis: at least 3 procedures with an interval of 12 weeks (up to a maximum of 6 procedures within one year). The results were analyzed using descriptive statistics and the parametric Student's t-test. Data processing was carried out using the Biostat software. The value of the level of statistical significance of differences was taken as p 0.05. Results. Evaluation of the effectiveness of treatment was carried out on the basis of an analysis of the immediate outcomes of the disease, the dynamics of clinical symptoms and the severity of acne: regression of inflammatory elements of acne, a decrease in the phenomenon of seborrhea, improvement of the skin relief. As a result of the therapy, a transition to remission was noted in 16.6% of patients, an improvement in their condition 36.7%, a significant improvement 46.7%. Conclusions. An integrated approach combining PRP procedures and bacteriophage therapy can serve as a pathogenetically substantiated strategy for treating acne. A promising direction for further research is the development of new regimens and combinations of alternative therapeutic strategies using bacteriophages.

The aim of the study was to reveal clinical and dynamic characteristics of affective disorders (AD) in comorbidity with alcohol addiction (AA). Materials and methods. 65 patients with affective disorders [22 women (34%) and 43 men (66%)] were examined. The main group included 34 patients aged 44.5 [36.0; 51.5] with affective disorders and comorbid alcohol addiction The comparison group included 31 patients aged 45 years [32; 52] with affective disorders without comorbid narcological pathology. Compared groups were matched by sex, age and nosological structure (p > 0.05). The following methods were used in the study: clinical and psychopathological, clinical follow-up, psychometric, statistical, as well as these psychometric scales: Clinical Global Impression (CGI), Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale (HARS), Social Adaptation Self-evaluation Scale (SASS). Results. The comparative assessment of clinical and dynamic characteristics of affective disorders and social adaptation level was conducted. Chronology of occurrence of comorbid affective disorders and alcohol addiction was analyzed. Conclusion. Addition of alcohol addiction to affective disorders worsens the clinical and dynamic indices and social adaptation level of patients.

Objective: to study the clinical and laboratory features of lobular panniculitides (LPn) on a cohort of patients referred to the rheumatology center.Patients and methods. The investigation enrolled 687 patients (613 women and 74 men; mean age, 39.7±11.3 and 41.2±12.5 years, respectively) with panniculitis (Pn) who had received outpatient and/or inpatient treatment for diagnosed erythema nodosum or panniculitis at the V.A. Nasonova Research Institute of Rheumatology in 2007–2017.Results and discussion. By applying the diagnostic algorithm developed by the authors and the existing classification of Pn, the investigators diagnosed septal Pn in 430 (62.6%) patients and LPn in 249 (36.2%). The latter was associated with rheumatic diseases (RDs) in 97 (39%) patients. Most (70%) cases were patients with idiopathic LPn (ILPn), which, according to the 10th edition of the International Classification of Diseases, belongs to a group of systemic connective tissue disorders (M35.6), as well as those with systemic lupus erythematosus (SLE) (11.45%), dermatomyositis (DM) (9.37%), and rheumatoid arthritis (7%). This group showed a preponderance of females (the ratio of males to females was 1:7) with the chronic course of the disease mainly in ILPn. The clinical picture corresponded to four types of LPn, which may be of diagnostic and prognostic value in RDs.Conclusion. This investigation confirmed the relevance of studying LPn in RDs because of its negative impact on the course, severity and therapeutic efficiency of the underlying disease.

Objective — to determine the clinical and epidemiological features of urogenital trichomoniasis in patients in Ukraine at the present stage.Materials and methods. 241 patients were examined (151 men and 90 women). For diagnostic purposes, microscopy in smears was performed and a culture study was carried out on the basis of M 305 broth (HiMedia, India). Real-time polymerase chain reaction (PCR) and test systems such as Litekh (Russia), DRG (USA), IBL (Germany), DyaSys (Germany) and DNA Diagnostics (Russia) were also used. The quality control of the studies was carried out in accordance with the requirements of ISO 9000. Special questionnaires were used to identify patients with violations of the reproductive system. The study of ejaculate was carried out according to WHO protocols. For statistical processing of the results, the Statistica 9.0 (Stat Soft) package was used.Results and discussion. The following microflora was found in patients: chlamydia in 116 (48.1 ± 3.2) %, mycoplasmosis in 87 (36.1 ± 3.1) %, gardnerellosis in 40 (16.6 ± 2.4) %. In addition, among 123 (77.2 %), herpes simplex virus type 1 and type 2 were detected in 118 (49.0 ± 3.2) %, cytomegalovirus in 19 (7.9 ± 1.7) %, Epstein-Barr virus in 8 (3.3 ± 1.2) % patients. In 26 (17 %) men, the disease was asymptomatic, and in 125 (83 %), a pathology of the genitourinary system was revealed. Urethritis was the main clinical syndrome in 58 (38 %), prostatitis — in 21 (14%), epididymitis — in 11 (7 %), balanoposthitis – in 23 (23 %) patients. Copulative and reproductive disorders were found in 12 (8 %) men. Among 90 women, 76 (74 %) were diagnosed with various pathologies: cystitis in 8 (9 %), vulvovaginitis in 17 (19 %), cervicitis in 9 (10 %), cervical erosion in 17 (19 %), adnexitis in 14 (15.6 %) patients. In 14 (16 %) women, an asymptomatic course of diseases was noted. Menstrual irregularities, infertility and sexual dysfunctions prevailed as the main syndrome in 11 (12 %) patients. Trichomoniasis is characterized by a low-symptom course, multifocal lesions, the presence of residual phenomena and complications. The invasion of Trichomonas vaginalis is able to cause mainly colpitis, vulvitis, cervicitis, endocervicitis, urethritis, prostatitis, epididymitis, cystitis. The severity of the inflammatory process increases in the presence of concomitant microorganisms. For the diagnosis of trichomoniasis, PCR (83—95 %) and the culture method were recognized as the most sensitive.Conclusions. Trichomoniasis continues to be one of the most common sexually transmitted infections in Ukraine. The disease has significant socioeconomic consequences. Features of the clinical manifestations of urogenital trichomoniasis in modern conditions are: attrition of the clinical picture, its frequent chronization, combination with other pathogens of the urogenital system, multi-focal lesions, and a high probability of developing serious complications. PCR and the culture method are recognized today as the most informative for the diagnosis of trichomoniasis., Цель работы — определить клинико-эпидемиологические особенности мочеполового трихомоноза у больных в Украине на современном этапе.Материалы и методы. Обследован 241 больной (151 мужчина и 90 женщин). С диагностической целью выполнена микроскопия в мазках и проведено культуральное исследование на основе бульона М 305 (HiMedia, Индия). Также использованы полимеразная цепная реакция (ПЦР) в реальном времени и такие тест-системы: «Литех» (Россия), DRG (США), IBL (Германия), DyaSys (Германия) и фирмы «ДНК-диагностика» (Россия). Контроль качества исследований осуществлен в соответствии с требованиями ISO 9000. Для выявления у больных нарушений со стороны половой системы применены специальные анкеты. Исследование эякулята проведено согласно протоколам ВОЗ. Для статистической обработки результатов использован пакет Statistica 9.0 (Stat Soft).Результаты и обсуждение. У больных обнаружена такая сопутствующая микрофлора: хламидиоз — у 116 (48,1 ± 3,2) %, микоплазмоз — у 87 (36,1 ± 3,1) %, гарднереллез — у 40 (16,6 ± 2,4) %. Кроме того, среди 123 (77,2 %) пациентов выявлены: вирус простого герпеса 1-го и 2-го типа — у 118 (49,0 ± 3,2 %), цитомегаловирус — у 19 (7,9 ± 1,7 %), вирус Эпштейна—Барр — у 8 (3,3 ± 1,2) %. У 26 (17 %) мужчин заболевание протекало бессимптомно, а у 125 (83 %) — выявлена патология со стороны мочеполовой системы. Основным клиническим синдромом у 58 (38 %) больных был уретрит, у 21 (14 %) — простатит, у 11 (7 %) — эпидидимит, у 23 (23 %) — баланопостит. Копулятивные и репродуктивные расстройства обнаружены у 12 (8 %) мужчин. Среди 90 женщин у 76 (74 %) диагностирована различная патология: цистит — у 8 (9 %), вульвовагинит — у 17 (19 %), цервицит — у 9 (10 %), эрозия шейки матки — у 17 (19 %), аднексит — у 14 (15,6 %). У 14 (16 %) женщин отмечено бессимптомное течение заболеваний. Наруше­ние менструального цикла, бесплодие и сексуальные расстройства превалировали как основной синдром у 11 (12 %) пациенток. Для трихомоноза характерны малосимптомное течение, многофокусные поражения, наличие рези­дуальных явлений и осложнений. Инвазия Trichomonas vaginalis способна обусловить преимущественно кольпит, вульвит, цервицит, эндоцервицит, уретрит, простатит, эпидидимит, цистит. Выраженность воспалительного процесса возрастает при наличии супутствующих микроорганизмов. Для диагностики трихомоноза наиболее чувствительными признаны ПЦР (83–95 %) и культуральный метод. Выводы. Трихомоноз продолжает оставаться одной из самых распространенных в Украине инфекций, передающихся половым путем. Заболевание имеет значительные социально-экономические последствия. Особенностями клинических проявлений урогенитального трихомоноза в современных условиях являются: стертость клинической картины, частая его хронизация, сочетание с другими возбудителями инфекций мочеполовой системы, многоочаговость поражений, высокая вероятность развития тяжелых осложнений. ПЦР и культуральный метод признаны на сегодня наиболее информативными для диагностики трихомоноза., Мета роботи — визначити клініко-епідеміологічні особливості сечостатевого трихомонозу у хворих в Україні на сучасному етапі.Матеріали та методи. Обстежено 241 хворого (151 чоловіка та 90 жінок). З діагностичною метою виконано мікроскопію в мазках і проведено культуральне дослідження на основі бульйону М 305 (HiMedia, Індія). Також використано полімеразну ланцюгову реакцію (ПЛР) у реальному часі і такі тест-системи: «Літех» (Росія), DRG (США), IBL (Німеччина), DyaSys (Німеччина) і фірми «ДНК-технологія» (Росія). Контроль якості досліджень здійснено відповідно до вимог ISO 9000. Для виявлення у хворих розладів з боку статевої системи застосовано спеціальні анкети. Дослідження еякуляту проведено згідно з протоколами ВООЗ. Для статистичної обробки результатів використано пакет Statistica 9.0 (Stat Soft).Результати та обговорення. У хворих виявлено таку супутню мікрофлору: хламідіоз — у 116 (48,1 ± 3,2) %, мікоплазмоз — у 87 (36,1 ± 3,1) %, гарднерельоз — у 40 (16,6 ± 2,4) %. Крім цього, серед 123 (77,2 %) пацієнтів діагностовано: вірус простого герпесу 1-го і 2-го типу — у 118 (49,0 ± 3,2) %, цитомегаловірус — у 19 (7,9 ± 1,7) %, вірус Епштейна–Барр — у 8 (3,3 ± 1,2) %. У 26 (17 %) чоловіків був безсимптомний перебіг захворювання, а у 125 (83 %) — визначено патологію з боку сечостатевої системи. Основним клінічним синдромом у 58 (38 %) хворих був уретрит, у 21 (14 %) — простатит, в 11 (7 %) — епідидиміт, у 23 (23 %) — баланопостит. Копулятивні і репродуктивні розлади виявлено у 12 (8 %) чоловіків. Серед 90 жінок у 76 (74 %) діагностовано різну патологію: цистит — у 8 (9 %), вульвовагініт — у 17 (19 %), цервіцит — у 9 (10 %), ерозію шийки матки — у 17 (19 %), аднексит — у 14 (15,6 %). У 14 (16 %) пацієнток відзначено безсимптомний перебіг захворювань. Порушення менструального циклу, безпліддя і сексуальні розлади превалювали як основний синдром у 11 (12 %) жінок. Для трихомонозу характерні малосимптомний перебіг, багатофокусні ураження, наявність резидуальних явищ і ускладнень. Інвазія Trichomonas vaginalis здатна спричиняти переважно кольпіт, вульвіт, цервіцит, ендоцервіцит, уретрит, простатит, епідидиміт, цистит. Виразність запального процесу збільшує наявність супутніх мікроорганізмів. Для діагностики трихомонозу найбільш чутливими виявилися ПЛР (83–95 %) та культуральний метод.Висновки. Трихомоноз продовжує залишатися однією з найбільш поширених в Україні інфекцій, що передаються статевим шляхом. Захворювання має значні соціально-економічні наслідки. Особливостями клінічних виявів урогенітального трихомонозу в сучасних умовах є: стертість клінічної картини, часта його хронізація, поєднання з іншими збудниками інфекцій сечостатевої системи, багатовогнищевість уражень, висока імовірність розвитку тяжких ускладнень. ПЛР та культуральний метод на сьогодні визнані найбільш інформативними для діагностики трихомонозу.

El sarampión es una enfermedad causada por un virus ARN del género Morbillivirus que forma parte de la familia Paramyxoviridae. Es una enfermedad altamente contagiosa, pero prevenible por vacunación. En los últimos años se ha documentado un creciente número de casos reportados tanto en países desarrollados como en vías de desarrollo, principalmente como consecuencia de cambios poblacionales e inadecuadas políticas y estrategias de vacunación, así como por el auge de los grupos antivacunas. Las manifestaciones clínicas se resumen en cuatro fases típicas de la enfermedad. Se estima que las tasas de mortalidad pueden ser hasta de 25%, principalmente en niños con comorbilidades como desnutrición o deficiencia de vitamina A. En este artículo se realiza una revisión y actualización de los aspectos epidemiológicos,clínicos y sobre vacunación de sarampión, en particular en varios países latinoamericanos. Destacamos la necesidaddel cumplimiento de políticas y estrategias de inmunización en todos los niveles a fin de evitar la propagación de brotes. Measles is a disease caused by an RNA virus of the Morbillivirus genus, which is part of the Paramyxoviridae family. Measles is highly contagious, but can be preventable by vaccination. In recent years, an increasing number of cases reported in both developed and developing countries, mainly as a consequence of population changes and inadequate vaccination policies and strategies, as well as the rise of anti-vaccine groups. Clinical manifestations are based on four typical stages of the disease. Mortality rates are estimated to be as high as 25%, primarily in children with comorbidities such as malnutrition or vitamin A deficiency. This article reviews and updates the epidemiological, clinical, and measles vaccination aspects, particularly in some Latin American countries. We highlight the need for compliance with immunization policies and strategies, in order to prevent the spread of outbreaks.

Guillain-Barré syndrome (GBS) is an immune-mediated peripheral polyradiculonevritis, which is clinically characterized by rapid, symmetrical progression of muscle weakness or paralysis, with or without sensitive symptoms. We report the case of a male child aged 4 years is presented for distal weakness in the lower limbs, impossibility of maintaining vertical posture, balance disorders, alternating sleepiness with episodes of psychomotor agitation and dysphonia, headache, with sudden onset about 12 hours before hospitalization. The presented case underlines the importance of accurately describing the clinical picture and evolution in establishing the diagnosis, in total or partial absence of paraclinical data. Also, the low number of cases described in medical jurnals justify the interest in investigating and publishing these cases.

The article is devoted to the issue of clinical and neurological features of primary brain tumors (PBT). PBT account for 2% of the total number of human tumors. PBT represent an urgent social problem, causing disability and mortality. The incidence rate of primary tumors of the brain and other parts of the central nervous system in the United States from 2011 to 2015 amounted to 23.03 cases per 100,000 population. The most common histological types of PBT: meningioma (36.4%), pituitary tumors (15.5%) and glioblastoma (15.1%). The clinical picture of PBT is represented by cerebral and focal symptoms. Neurological deficit is determined by the location and volume of the neoplasm. The initial manifestations of tumor growth may be symptoms of irritation of the squeezed area of the brain tissue, which will be replaced later by symptoms of prolapse. Cerebral symptoms in most cases are associated with increased intracranial pressure and the development of cerebral edema. The subsequent development of the tumor process leads to the dislocation of brain structures and the formation of wedge syndromes. The most common clinical symptoms are: cognitive deficit (36%), convulsive syndrome (35%), headache (31%), ataxia (24%) and motor deficiency (22%). The article summarizes the data of world and domestic clinical studies aimed at determining the prevailing symptoms of primary brain tumors for the purpose of early diagnosis, timely medical care and assessment of the effectiveness of the treatment. Knowing the specifics of the clinical picture will significantly increase oncological alertness, which will lead to early diagnosis and timely treatment of PBT, which play a key role in improving the quality of life and increasing its duration.

Purpose and objectives Given their role in homing immune cells to the intestine, CC motif chemokine receptor 9 (CCR9) and its specific ligand CC motif chemokine ligand 25 (CCL25) are interesting candidate genes for celiac disease. These genes are located in regions previously shown to be associated with or linked to celiac disease, but no investigations on their association with various celiac disease phenotypes have so far been conducted. Here we studied such associations of both genotyped and imputed single nucleotide polymorphisms (SNPs) with either regulatory function or exonic location of the CCR9 and CCL25 loci. Results Exploiting a carefully phenotyped cohort of 625 celiac disease patients and 1817 non-celiac controls, we identified that multiple SNPs with predicted regulatory function (RegulomeDB score ≤3a and/or eQTL effect) located between 100 kB upstream and downstream of CCR9 and CCL25 are associated with celiac disease and/or selected phenotypes. Of the genotyped SNPs in the CCR9 loci, rs213360 with an eQTL effect on CCR9 expression in blood was associated with celiac disease and all investigated phenotypes except high HLA risk. Rs1545985 with an eQTL on CCR9 expression and rs7652331 and rs12493471, both with RegulomeDB score ≤3a, were all associated with gastrointestinal symptoms and malabsorption and the latter additionally with anemia. The genotyped CCL25 SNPs rs952444 and rs882951, with RegulomeDB scores 1d and 1f respectively and eQTL effect on CCL25 expression in small intestine, were associated with gastrointestinal symptoms and malabsorption. The CCL25 SNP rs2303165 identified in sequencing followed by imputation was associated with partial villous atrophy. However, the association did not pass the permutation based multiple testing correction (PEMP2 > 0.05). Conclusions We conclude that SNPs in the region of CCR9 and CCL25 with predicted functional effect or exonic localization likely contribute only modestly to various celiac disease phenotypes., Highlights • CCR9-CCL25 axis is an important modulator of intestinal homeostasis and intolerance. • Association of CCR9 and CCL25 loci with different celiac disease phenotypes remains obscure. • Several SNPs within CCR9 and CCL25 were weakly associated with various celiac disease phenotypes. • SNPs in the CCR9 and CCL25 regions likely contribute modestly to the celiac disease phenotype.

Covid-19 pandemic is in a massive second wave in India. The new variant is considered more infectious. Diabetic patients are considered more vulnerable to develop some of the complications of acute Covid-19 infections. Furthermore, steroids are being used in the treatment of Covid-19 related pneumonia in a large number of patients. Hence, secondary fungal infections are being increasing observed, with very high mortality. We present the clinical, imaging and histopathological features in a diabetic patient who recovered from acute Covid-19 infection. However, he developed palatal and maxillary mucormycosis. Mucosal debridement, sinus surgery and antifungal treatment led to a satisfactory outcome.

Meningitis is characterized by the prevalence of severe forms and it is often accompanied by life-threatening syndromes.Purpose. To determine the most informative clinical manifestations of meningitis in children in their first years of life to optimize early diagnosis and treatment.Materials and methods. The authors carried out a retrospective analytical study involving 47 cases of children hospitalized to the Republican Clinical Hospital for Infectious Diseases in 2014–2016. Their diagnose was based on the acute onset of the disease, characteristic clinical symptoms and the results of lumbar puncture. The laboratory diagnostics included a standard set of examinations.Results. Meningitis was diagnosed in 34 patients (72.3%), meningoencephalitis – in 13 patients (27.7%). 30 cases (63.8%) of meningitis / meningoencephalitis had a bacterial nature, and 9 cases (19.1%; pConclusion. The most significant symptoms of early diagnosis of meningitis in children are high febrile fever combined with drowsiness and retardation, vomiting without diarrhea.

Aim. To identify clinical, epidemiological and laboratory-instrumental features of acute hepatitis C at the present stage according to the infectious hospital data. Methods. The study included 111 patients with acute hepatitis C aged from 18 to 79 years who were hospitalized in Republican Clinical Infectious Diseases Hospital named after A.F. Agafonov in 2011 - I quarter of 2017. Acute hepatitis C was diagnosed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Results. In the study group, females aged 21 to 40 years, non-working, predominantly living in Kazan with medical transmission of infection (34 %) prevailed. The disease was mild and moderately severe (71 %). The icteric form was observed in 94 % of patients, in 3.6 % - with a cholestatic component. When comparing laboratory parameters, markers of cytolysis and cholestasis differed significantly in patients depending on the severity (p

WOS: 000545984600039 PubMed: 32584747 [No abstract available]

Background Premenstrual syndrome (PMS) and its more severe form premenstrual dysphoric disorder (PMDD) are highly prevalent conditions, but there seems to be ethnic and cultural variances in their distribution. Aims To explore the prevalence of PMS/PMDD and their typical clinical features in a Bulgarian population. Materials and methods This investigation was designed and executed as a cross-sectional descriptive study. Three hundred and five conveniently recruited females with no psychiatric history filled in a self-evaluation questionnaire based on DSM-IV tapping on different symptoms of PMS. The prevalence of the conditions was calculated. Results 32.1% (N = 98) of the tested females (mean age 31.04 ± 6.31) suffered from PMS and 3.3% (N = 10) were diagnosed with PMDD. The leading symptoms in the sample were irritability, fatigue and changes in appetite, depressed mood, mood swings, and anxiety, and abdominal bloating, breast tension and tenderness. Most of the symptoms were moderately severe. Mild and moderate cases of PMS were near equally distributed and more frequent than severe ones. Conclusion PMS is a common condition which is usually mildly expressed, but severe cases are not an exception. The clinical picture is dominated by almost equally distributed psychological and somatic symptoms.

В настоящее время имеются немногочисленные данные о влиянии коронавирусной инфекции COVID-19 на течение беременности, родов, состояние плода и послеродовый период. В данной статье нами было проанализирована деятельность родильных домов инфекционного профиля ТОО «Smart Health university City» и «Родильный дом №4» г. Алматы. В статье также описаны течение коронавирусной инфекции COVID-19 у 1110 беременных, рожениц и родильниц, а также состояние новорожденных, рожденных от матерей с подтвержденной COVID-19. По результатам анализа выявлено COVID-19 у беременных, рожениц и родильниц 58,9% и 55,8% соответственно. В зависимости от сроков гестации наиболее высокий показатель подтвержденных СOVID-19 выявлено среди беременных со сроком гестации 23-36 недель и 37 недель и более. Среди всех поступивших диагностирована пневмония у 194 (23,9%) женщин. От общего числа родов 298 (36,7%), только в двух случаях у новорожденных от матерей COVID-19 результат анализа на COVID-19 показал «как положительный», а в остальных 296 случаях (99,3%) новорожденных, родившихся от матерей COVID-19 результаты анализов на COVID-19 были «отрицательные»., Currently, there are few data on the impact of coronavirus infection COVID-19 on pregnancy, childbirth, fetal health and the postpartum period. In this article, we have analyzed the activities of maternity hospitals of infectious profile LLP «Smart Health university City» and «Maternity hospital No. 4» in Almaty. The article also describes the course of coronavirus infection COVID-19 in 1110 pregnant women, women in labor and parturient women, as well as the condition of newborns born to mothers with confirmed COVID-19. According to the results of the ANALYSIS, covid-19 was detected in pregnant women, women in labor and women in labor, 58.9% and 55.8%, respectively. Depending on the gestational age, the highest rate of confirmed COVID-19 was found among pregnant women with a gestational age of 23-36 weeks and 37 weeks or more. Among all admitted patients, 194 (23.9%) women were diagnosed with pneumonia. Of the total number of births, 298 (36.7%), only in two cases in newborns from COVID-19 mothers, the test result for COVID-19 showed «as positive», and in the remaining 296 cases (99.3%) of newborns born from COVID-19 mothers, the results of tests for COVID-19 were «negative».

В данной статье проанализированы случаи тромбоэмболии легочной артерии (ТЭЛА) по данным регионального сосудистого центра (РСЦ) Амурской областной клинической больницы (АОКБ) за 2-ое полугодие 2018 г. Проанализированы характерные для данного заболевания показатели диагностических данных, критерии факторов риска, возраст пациентов. На основе анализа численности заболевших, результативности диагностических данных, а также характера взаимодействия патологии вен с другими факторами риска определяется вероятность возникновения тромбоэмболии легочной артерии. Выявлена и обоснована необходимость в профилактических мероприятиях на разных этапах лечения ТЭЛА., The aim of this article is to analyze the cases of pulmonary embolism (PE) for the second part of 2018 according to the Regional Vascular Center (RVC). The indices of diagnostic data, which are typical to this disease, criteria of risk factors and age of patients have been analyzed. Probability of pulmonary embolism origin is determined on the basis of the analyses of the number of the diseased people, successful diagnostic data and also on the interaction character of this pathology with other risk factors. The necessity in the prophylactic measures on different stages of therapy of this disease is also detected

Травма нервов, несмотря на свою небольшую частоту, представляет значительную медико-социальную проблему, поскольку характеризуется длительным нарушением функции конечности и высоким уровнем инвалидизации. Повреждения периферических нервов достигают 4 % от всех травм составляют большую медико-социальную проблему, поскольку характеризуются значительным и длительным снижением функции конечности, высоким уровнем инвалидизации больных. Как показывает наш многолетний опыт и анализ мировой литературы, несмотря на внедрение новых диагностических и микрохирургических методик в лечении повреждений периферических нервов остается ряд проблем, связанных с несвоевременным и неточным установлением диагноза, ошибками в прогнозировании восстановления, рядом тактических ошибок, а именно: необоснованное выполнение или, наоборот, отсутствие восстановительных вмешательств на нервных стволах и проч.

This paper presents findings of the survey into studying the adjustment of children from internally displaced families (IDP). Theaimof the present research was to identify clinical peculiarities of adjustment disorders in children from IDP families. Materials and methods.The survey examined 66 children with AD signs from IDP families aged 7-18, the average age was 10.32±0.09 years old. The research was focused on studying children's personality traits using the “Adjusted Modified Variant of R.B. Cattell's Children's Personality Questionnaire (CPQ) (adjusted by E.M. Aleksandrovska, I.N. Giliasheva, 1993),anxiety values were registered by Spilberg-Khanin Anxiety Scale (2007), aggression and autoaggression levels were identified by Buss-Durkee Hostility Inventory (BDHI) (adjusted by O. Osnytskyi, 2008). Results. The obtained data testify to the complexity and diversity of the clinical picture of adaptation disorders in this category of patients. The violations of emotional-volitional, value-motivational and cognitive spheres are identified in the form of isolation, coldness, rigidity and alienation, and cruelty. It is stated that the activity of establishing and storing contacts with others is low. Found high rates of anxiety, resulting in the presence of anxiety, neurotic conflicts, emotional and neurotic breakdowns, psychosomatic disorders and diseases. Also, the tendency to aggression and autoaggression, the tendency to use physical force and aggressiveness to others, and the tendency to use physical violence and rudeness were revealed. Proved dependent formation of a high level of aggressiveness on the presence of children from families with RA IDPs physical, verbal and indirect aggression, high index of manifestations of hostility and resentment of suspicion, motivated aggressive activity from physical and verbal aggression and irritation. Conclusions.Adaptation disorders in paediatric patients from families of IDPs are an acute problem of modern psychiatric science. The findings bring us to the conclusion that there is a need for a more detailed study of adjustment disorders to elaborate clinical peculiarities of diagnostic criteria and targets in psychotherapeutic correction of the abovementioned disorders

Two cases of rare dermatosis — chronic atrophic acrodermatitis are described. Etiology of disease, clinical manifestations, differential diagnosis are presented., Описаны два случая редкого дерматоза — хронического атрофического акродерматита. Представлены причины болезни, клинические проявления и дифференциальная диагностика., Описано два випадки рідкісного дерматозу — хронічного атрофічного акродерматиту. Показано причини хвороби, наведено клінічні вияви та диференціальну діагностику.

The lecture presents modern views on risk factors, pathogenesis, and the main morphological criteria for granulomatosis with polyangiitis (Wegener granulomatosis). Clinical manifestations, imaging findings of pulmonary syndrome in the aforementioned systemic vasculitis as well as the main diagnostic criteria and the principles of treatment are highlighted in detail.

The introduction of genotype II African swine fever (ASF) virus, presumably from Africa into Georgia in 2007, and its continuous spread through Europe and Asia as a panzootic disease of suids, continues to have a huge socio-economic impact. ASF is characterized by hemorrhagic fever leading to a high case/fatality ratio in pigs. In Europe, wild boar are especially affected. This review summarizes the currently available knowledge on ASF in wild boar in Europe. The current ASF panzootic is characterized by self-sustaining cycles of infection in the wild boar population. Spill-over and spill-back events occur from wild boar to domestic pigs and vice versa. The social structure of wild boar populations and the spatial behavior of the animals, a variety of ASF virus (ASFV) transmission mechanisms and persistence in the environment complicate the modeling of the disease. Control measures focus on the detection and removal of wild boar carcasses, in which ASFV can remain infectious for months. Further measures include the reduction in wild boar density and the limitation of wild boar movements through fences. Using these measures, the Czech Republic and Belgium succeeded in eliminating ASF in their territories, while the disease spread in others. So far, no vaccine is available to protect wild boar or domestic pigs reliably against ASF.

The lecture presents modern views on risk factors, etiology, pathogenetic mechanisms of the development as well as morphological criteria of hypersensitivity pneumonitis. Clinical manifestations, the variants of the clinical course in particular, X-ray results, external respiration disturbances, immunological criteria, as well as the treating principles of hypersensitivity pneumonitis in children, are highlighted in detail.

Despite the great efforts by health authorities in Kingdom of Saudi Arabia (KSA), Cutaneous leishmaniasis (CL) continues to be a major public health problem in the country. Many risk factors make KSA prone to outbreaks and epidemics; among these, rapid urbanization and the huge population movement are the most important. The disease is endemic in many parts of KSA, with the majority of cases concentrated in six regions, including Al-Qaseem, Riyadh, Al-Hassa, Aseer, Ha'il, and Al-Madinah. Leishmania major (L. major) and Leishmania tropica (L. tropica) are the main dermotropic species, and Phlebotomus papatasi (vector of L. major) and Phlebotomus sergenti (vector of L. tropica) are the proved vectors of the disease. Psammomys obesus and Meriones libycus have been defined as the principal reservoir hosts of zoonotic CL in Al-Hassa oasis, Al-Madinah, and Al-Qaseem provinces. Clinically, males are affected more than females, and there is no variation between the Saudis and expatriates in terms of number of reported cases, but the disease tends to run a more severe course among non-Saudis. Face is the most commonly affected site, and ulcerative pattern accounts for 90% of lesions. Despite local and international recommendations of using laboratory diagnostics to confirm CL cases, most cases in KSA are diagnosed and treated on clinical grounds and local epidemiology. However, systemic parenteral sodium stibogluconate (SSG) is the first line of therapy and used to treat all CL patients irrespective of their clinical presentation or the incriminated species. In brief, more efforts are needed to combat this disease. Several aspects of the disease require more evaluation through encouragement of national and regional studies. Development of evidence based national diagnostic and management guidelines, as well as algorithms, is urgently needed to improve the practice of diagnosing and treating CL in KSA.

Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder that belongs to class I histiocytoses and is characterized by infiltration of one or many organs by Langerhans cells to form granulomas. The literature analysis could identify a lot of etiological, pathogenetic, and trigger factors and mechanisms for LCH development, which determine the diversity of the clinical picture and course of the disease. The clinical manifestations of LCH are very variable and depend on the severity of lesions and the age of patients. In addition to skin lesions, there is involvement of one or more visceral organs. Difficulties in diagnosing the disease lead to statistical variations of LCH in different countries of the world and require more attention by physicians of all specialties.Лангергансоклеточный гистиоцитоз (ЛКГ) - редкое клональное пролиферативное нарушение, относящееся к 1-му классу гистиоцитозов и характеризующееся инфильтрацией одного или многих органов клетками Лангерганса с образованием гранулем. Анализ литературы позволил определить множество этиологических, патогенетических, пусковых факторов и механизмов развития ЛКГ, обусловливающих разнообразие клинической картины и течения заболевания. Клинические проявления ЛКГ очень вариабельны и зависят от тяжести поражений и возраста больных. Кроме поражения кожи отмечается вовлечение в процесс одного или более внутренних органов. Трудности диагностики заболевания служат причиной статистических вариаций ЛКГ в разных странах мира и нуждаются в повышенном внимании врачей всех специальностей.

Purpose: The article contains results of the comparative analysis of dynamics of immunological parameters in the clinical period at children with an infectious mononucleosis of moderate severity during the acute period at treatment by the drugs “Anaferon kids “ and “Viferon” and further, in a catamnesis, within 6 years. The materials and methods: In group of research was 187 children. Three groups were created: the I group (n=75) – the patients receiving during the acute period « Anaferon kids » and pathogenetic therapy, the II group (n=72) – « Viferon » and pathogenetic therapy, the III group (n=40) – only with pathogenetic therapy. Results: Against the background of therapy with « Anaferon kids » and « Viferon » normalization of clinical symptoms and laboratory indicators came quicker in comparison with group of the children receiving only symptomatic therapy. At observation in a catamnesis, at all children the high rate of recurrent respiratory diseases was noted by viral infections. Changes in immunologic indicators became perceptible in all three groups throughout the entire period of observation.

Aim: To characterize the modern trends of the hepatitis A clinic in adults with markers of the hepatitis B virus. Materials and methods: The study included 124 patients with hepatitis A, were hospitalized in Clinical Infectious Diseases Hospital named after S.P. Botkin in the period from 2012 to 2015. Diagnosis of hepatitis A and chronic hepatitis B was established on the basis of clinical and epidemiological criteria, confirmed by the results of a laboratory study. Two groups of patients were identified: 1 group – patients with hepatitis A as a monoinfection (n=85), 2 group – patients who had hepatitis A on a background of chronic hepatitis B (n=39). Results: An analysis of the age structure revealed that patients of the second group were older than the first. The analysis of gender structure established the same ratio of women and men (51,0% and 49,0%, respectively, p> 0,05) in the first group, in the second group the prevalence of women was found (64,0% and 36,0% respectively; p=0,001). General weakness, decreased appetite, and fever were more common for patients in the second group. Skin pruritus was more often in the first group. A comparative analysis of the two variants of hepatitis A showed that monoinfection of hepatitis A often occurs in mild form (47,0% and 18,0%, respectively, p=0,001). The severe form of the disease developed more often in patients of the second group (28,0% and 13,0%, respectively, p=0,02). Duration of hospitalization of patients and duration of icteric period was longer for hepatitis A on a background of chronic hepatitis B, regardless of the degree of severity. Conclusion: Modern hepatitis A in a third of cases is combined with chronic hepatitis B in people older than 40 years, and characterized by a higher frequency of severe icteric forms with severe cytolytic syndrome and requires a long hospitalization, which is accompanied by significant economic damage.

The purpose of the research was studying of features of clinic, course, medical tactics and outcomes of infectious endocarditis in 25 patients suffering from “salt” drug addiction. Materials and methods: we examined 25 patients with infectious endocarditis, the host “salt” intravenously. To verify the diagnosis in addition to standard studies of blood, urine, sputum, was performed transthoracic EchoCG, x-ray study of the chest (twice, at admission and before discharge of the patient from the hospital). For certain indications used diagnostic fiber-optic bronchoscopy and computed tomography of the lungs, consulted a neurologist, cardiologist, infectious disease. Results and discussion: 84% of patients diagnosed with HIV. The acute course of the disease and presence of accompanying pathology of organs and systems was observed in the majority of patients, with a predominance of neurological changes (88%). Typical meager cardiac symptoms (noise in the region of the heart were heard in 12% of patients), frequent lung as a result of pulmonary embolism (64%). Identified infectious agents (in most cases Staphylococcus aureus -32%), the defeat of the heart valves according to the EchoCG (in 72% of patients vegetation on tricuspid valve with varying degrees of regurgitation). The choice of antimicrobial medicines was optimized (cephalosporins I-III generation, aminoglycosides, vancomycin). The positive outcome of a disease was observed in 84% of patients, mortality was 16%. Conclusions: for infectious endocarditis injecting a “salt” of the drug revealed the following: acute disease; pronounced General symptoms, atypical clinical picture, involvement of the heart valves, lungs result in pulmonary embolism, early development of multiple organ failure, high mortality. In comparison with injection drug users who inject other drugs, “salt” addicts are characterized by the frequent development of infectious endocarditis, which is apparently connected with the influence of “salt” on the immune system and joining the bright and varied neurological symptoms.

Острый тонзиллофарингит представляет собой воспаление небных миндалин и задней стенки глотки. Ключевым симптомом данной патологии является боль в горле один из самых частых поводов для обращения к педиатру. В подавляющем большинстве случаев острый тонзиллофарингит имеет инфекционную природу, при этом этиологическая структура заболевания крайне разнообразна.

Клиническое картина и течение инфекционного эндокардита полиморфны и зависят от этиологического агента, сроков начала антимикробной терапии, наличия предшествующей патологии сердца и других органов мишеней.

Background: Risk stratification allows guiding treatment for patients with heart diseases. We aimed to provide clinical rules for identifying patients at high risk for mortality owing to heart failure. Methods: The research was a secondary analysis of data from a community cohort study that had been conducted from October 2007 to December 2011 in the United States. In total, 425 adult patients (180 women) with heart failure had been included. The mean (SD) age was 73·5 (13·1) years, and participants had been followed for 2 years. The outcome was mortality and the predictors were a variety of demographic, clinical, and laboratory variables. Results: We recognized two clusters of patients in the sample with different survival probabilities (P